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Presentation Retaining Value and Quality in a changing healthcare - - PowerPoint PPT Presentation

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Public Hearing Presentation Retaining Value and Quality in a changing healthcare landscape Teddy Mosomothane 17 May 2016 Embracing the opportunity to contribute We appreciate the inquiry process as partly leading towards recommendations

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Teddy Mosomothane

17 May 2016

Public Hearing Presentation Retaining Value and Quality in a changing healthcare landscape

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SLIDE 2

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Embracing the opportunity to contribute

 We appreciate the inquiry process as partly leading towards recommendations on:

  • Appropriate policy and regulatory mechanism that would

support the goal of achieving accessible, affordable, innovative and quality private health care;

  • Role
  • f

competition policy and competition law in achieving pro-competitive outcomes in health care.  Bankmed intends to share some insights primarily from a closed medical scheme perspective in the banking industry.

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SLIDE 3

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. About Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

3

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SLIDE 4

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

About Bankmed

 Collaboration among bankers, going back to 1914  Not-for-profit restricted medical scheme in the banking industry  Healthcare funding to more than 50 financial institutions  107 553 principal members, 216 262 beneficiaries (31/12/2015)  Market share:

  • 2.55% of the total industry’s principal members

(and 2.31% of beneficiaries)

  • 6.16% of the restricted medical schemes’ principal

members (5.20% of beneficiaries)

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SLIDE 5

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Bankmed Vision & Mission

Vision

To be the Medical Scheme of Choice for the Banking Industry 

Mission

To be an affordable Medical Scheme that guarantees best-of-class member experience, value and quality

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SLIDE 6

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Strategic Overview

Competitive Benefit Offering Service Excellence Health & Wellness Relevance in a changing environment

Integrated digital strategy Innovation / Research & Development Value to members

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SLIDE 7

Value Network Analysis (limited to core deliverables)

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Partnership Philosophy Collaborate optimally, extract as much value as possible from the partnership, while maintaining the Scheme’s brand identity, and an appropriate level of autonomy

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SLIDE 9

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Bankmed Value Attributes

What sets Bankmed apart

33%

Better value

AA +

42,5%

vs

33,3% 9%

vs industry average of

11%

6

Benefit Options

Compared to an average Open scheme Global Credit Rating – 2015 (Highest in the Industry) Solvency Ratio (2015) vs Industry Average (2014) Non-healthcare Expense Ratio

(Administration, Managed Healthcare & General Administration expenses)

A fair spread of benefits providing for low to high Healthcare needs and affordability

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

 Bankmed retained an AA+ credit rating in 2015, the highest rating a medical scheme can attain.  Rating assigned by Global Credit Ratings (GCR).  Bankmed is one of only two South African medical schemes with an AA+ credit rating.  Attributes contributing to the AA+ rating according to GCR:

  • Strong earnings capacity which is well managed
  • Large and stable membership base with a favourable age

profile

  • High level of solvency and strong historical track record
  • Large and diverse investment portfolio generating significant

investment returns at reasonable risk levels

Bankmed AA+ Credit Rating

10

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SLIDE 11

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

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Bankmed benchmarking - 2016

  • Benchmark against 128 options offered by 12 leading open membership medical schemes

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Bankmed benchmarking - 2016

  • Benchmark against 128 options offered by 12 leading open membership medical schemes

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Bankmed benchmarking - 2016

  • Benchmark Bankmed against 12 leading open membership medical schemes
  • Results as a percentage of Bankmed contributions:

Cost Benefit Value PMB Plan

  • 66%
  • 44%

22% Basic Plan

  • 13%

15% 28% Core Saver Plan

  • 24%

1% 25% Traditional Plan

  • 34%

3% 36% Comprehensive Plan

  • 19%

19% 38% Plus Plan

  • 26%

6% 32%

  • 22%

11% 33%

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Bankmed benchmarking - 2016

  • Benchmarking exercise:

– Bankmed members would (on average) be 33% worse off on an equivalent open membership medical scheme option – The calculations of relative value have been prepared by Willis Towers Watson using the Bankmed 2015 membership and claims profile – The value differential has increased each year from 2013 to 2016

  • Reasons for the value differential:

– The value differential of 33% can be only partly explained by the younger age profile

  • f the Bankmed membership (12%) and the lower non healthcare costs (3%)

– The unexplained value differential (18%) is due to the compulsory nature of the Bankmed membership

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employers Groups can protect the Bankmed risk pool from the loss of younger / healthier members to a large degree by retaining the condition

  • f employment that requires membership of

Bankmed This will enable the Employer Groups to offer their employees access to affordable private healthcare

  • n a sustainable basis in the future.

Protecting Our Future

  • and the Future of Our Members

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SLIDE 17

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

17

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Partnerships in Health

 Aligned health and wellness strategies  Sharing of information on the health of the organization  Monitor performance of the health and wellness initiatives

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Group Client Reporting

 Demographic overview  Claims & Utilization  Clinical Review  HIV/AIDS  Personal Health Assessment (PHA) and Individual Stress Assessment (ISA)

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Membership by Gender (Jan – Dec 2014)

57,04% 55,46% 42,96% 44,54%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% Female Male

Employer Client: X Bankmed

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SLIDE 21

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Membership by Age (Jan – Dec 2014)

0,06% 23,34% 32,06% 17,56% 11,48% 4,81% 10,68% 0,04% 22,89% 33,10% 17,34% 11,32% 4,57% 10,74%

0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00%

0 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 - 65 66+

Bankmed Employer Client: X

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SLIDE 22

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Membership by Dependant (Jan – Dec 2014)

43,41% 28,30% 14,37% 10,41% 2,87% 0,53% 0,11% 44,77% 29,15% 14,08% 9,25% 2,29% 0,40% 0,06%

0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00% 40,00% 45,00% 50,00% M+0 M+1 M+2 M+3 M+4 M+5 M+6+ Bankmed Employer Client: X

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Membership by Income Band (Jan – Dec 2014)

6,32% 37,77% 55,91% 5,70% 26,47% 67,84%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00% 80,00%

R0 - R5 000 R5 001 - R10 000 R10 000+ Bankmed Employer Client: X

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Membership Duration (Jan - Dec 2014)

7,75% 18,00% 10,90% 25,87% 37,49% 8,97% 15,55% 10,51% 25,22% 39,75%

0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00% 40,00% 45,00%

>1 yr 1-3 yrs 3-5 yrs 5-10 yrs > 10 yrs Bankmed Employer Client: X

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Wellness & Preventative Care

Percentage Utilisation X 2014 Bankmed 2014 Mammogram coverage 24.29% 29.92% Cervical Cytology coverage 38.31% 42.71% Bone Densitometry coverage 4.84% 8.81% PSA Screening 29.84% 45.61% Colorectal Cancer Screening 1.67% 3.11% Glaucoma Screening 9.39% 15.53% HCT Coverage 3.71% 6.27% Beneficiaries Visiting Dentists (|>2yrs) 22.20% 36.15% PHA Coverage 7.57% 19.94%

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X High Risks 2014

1,95% 3,71% 2,10% 2,79% 11,32% 11,70% 10,94% 9,53% 4,65% 5,36% 3,73% 4,57%

0,00% 2,00% 4,00% 6,00% 8,00% 10,00% 12,00% 14,00%

Diabetes Hyperlipidaemia Hypertension Employer Client: X Female Employer Client: X Male Bankmed Female Bankmed Male

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X - Abnormal Waist Circumference 2013 and 2014

36,10% 41,01% 37,42% 26,63% 28,66% 25,20%

0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00% 40,00% 45,00% Female >90 Male >100

Employer Client: X 2014 Bankmed 2014 Employer Client: X 2013

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X HIV Provincial Distribution by Gender

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X - HIV Provincial Distribution by Gender and Age

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X - HIV Disease Management Enrolees

Employer Client: X 2013 Employer Client: X 2014 Bankmed 2014 Females 789 (78.27%) 807 (77.29%) 2 209 (70.06%) Males 219 (21.72%) 237 (22.70%) 944 (29.93%) Total 1 008 1 044 3 153 Post Exposure Prophylaxis (monthly average) 3.33 1.08 6.16 Deceased 5 6 22

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Number of HCTs completed per Annum

2 348 1 709 9 998

2 000 4 000 6 000 8 000 10 000 12 000

Employer Client: X 2014 Bankmed 2014 Employer Client: X 2013

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X - Number of Tested Positive

2,08% 1,11% 2,09% 1,32% 1,89% 1,67%

0,00% 0,50% 1,00% 1,50% 2,00% 2,50% Female Male

Employer Client: X 2014 Bankmed 2014 Employer Client: X 2013

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X HCTs % Enrolled

78,79% 34,78% 68,52% 60,00% 50,00% 71,74%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00% 80,00% 90,00% Female Male

Employer Client: X 2014 Bankmed 2014 Employer Client: X 2013

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X ISAs per Annum

925 233 369 386 1311 1749

200 400 600 800 1000 1200 1400 1600 1800 2000

2009 2010 2011 2012 2013 2014

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Most significant Stressors reported

0% 10% 20% 30% 40% 50% 60% 70%

Social stressors e.g. friends, social isolation, religious… Health-related stressors e.g. chronic illness Environmental stressors e.g. crime, pollution, living… Children or family stressors Personal relationship difficulties Personal financial stressors Work-related stressors and job stress

38% 41% 47% 50% 50% 59% 64%

Most significant stressors reported

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Top 5 Surgical Admissions

Procedure Type Admissions 2013 Admissions 2014 Cost / Admission (2014) Caesarean Delivery 545 545 R25 083 Dental Procedures 459 471 R8 692 Ophthalmic Biopsies and Excisions 399 461 R10 356 Stomach and Duodenal Procedures 570 448 R21 097 Urinary Functional Procedures 330 420 R16 060

36

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Top 5 Medical Admissions

Procedure Type Admissions 2013 Admissions 2014 Cost / Admission (2014) Pneumonia 402 349 R17 994 Maternity 332 367 R30 192 Major Depression 203 198 R18 708 Paediatric/Neonates 74 72 R31 767 Cardiac Failure N/A 60 R37 963

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Top 5 Chronic Medication spend 2013 vs. 2014

2013 2014 Rank Condition

  • No. of

Claimants Rank Condition

  • No. of

Claimants 1 Hypertension 7 130 1 Hypertension 7 127 2 Hyperlipidaemia 3 983 2 Hyperlipidaemia 4 125 3 Coronary Artery Disease 2 702 3 Coronary Artery Disease 2 753 4 Hypothyroidism 2 079 4 Depression 2 177 5 Depression 1 969 5 Hypothyroidism 2 129

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Chronic Medication Compliance

37,06% 53,50% 63,81%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00% 70,00%

2012 2013 2014

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Care Plan Services Compliance

32,02% 42,98% 47,71%

0,00% 10,00% 20,00% 30,00% 40,00% 50,00% 60,00%

2012 2013 2014

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Cancer type by number of Enrolees

262 187 75 75 49 283 204 83 71 54

50 100 150 200 250 300

Breast Cancer Prostate Cancer GIT Dermatological Cancer Lymph Nodes & Lymphoma

2013 2014

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Employer Client: X Summary of Risks

11,32% 4,65% 1,95% 9,89% 41,01% 11,70% 5,36% 3,71% 5,36% 28,66%

0,00% 5,00% 10,00% 15,00% 20,00% 25,00% 30,00% 35,00% 40,00% 45,00%

Hyperlipidaemia Hypertension Diabetes Smoking Obesity

Female Male

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Recommendations and the Way Forward

 Focussed approach at Wellness Experiences Days (Dietician)  Online Stress Assessment (early ID of at risk for depression)  Quarterly Wellness Forums (align Bankmed Wellness Strategy with Employer Group Strategy)  On-going screening (not limited to Wellness Experience Days): employer driven competition amongst BUs. CEO to lead by example  Regional Strategy for increasing screening Call centre strategy  Move from fragmented to integrated wellness offering

43

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SLIDE 44

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

44

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Health Quality Assessment

 Benchmarking exercise in the funding industry  Highlights key quality issues in the SA medical scheme industry  Drives improvement in the delivery of evidence-based medicine  18 participating Schemes in the 2014 HQA  Comprised of 88 benefit options  Represented 6,78 million beneficiaries (77,21% medical scheme population)  Four categories are evaluated, namely:

  • Prevention and Screening
  • Hospitalization
  • Maternity and New-born
  • Chronic Disease Management

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SLIDE 46

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

46

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

The challenge of behaviour change

 Individual member’s responsibility  Opportunity to embrace innovative interventions  Regulatory obstacles  Prevention better than cure  Shift away from hospicentricity  Flexibility in response to unintended consequences

47

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SLIDE 48

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

48

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SLIDE 49

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Phased approach to change

 Lessons on collaboration  Acknowledging current reality  Carrying forward successful practices  Interim dispensations in a changing landscape

49

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SLIDE 50

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

50

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Outcome of Tender Process

Strong business case, based on a combination

  • f the evaluation criteria, to appoint the

successful bidder – which was a new administrator.

51

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Triggers of the Tender Process

The tender process itself was triggered by the following factors and considerations:  Good Governance: considered good governance practice to occasionally test the market with a view to evaluating whether or not the Scheme (and ultimately the members) is / are getting the best value via key outsourced service providers.  The Scheme also identified a need for a more “Integrated service offering”  An opportunity for the Scheme to refresh its “Service delivery” requirements, and evaluate proposals from competing bidders  An opportunity to secure a “Competitive price” for the refreshed service delivery offering, in the best interest of the Scheme and its members

52

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The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Tender Process Outline

 Used independent Tender Administrator  Robust process  Compliance with procurement policy  Expert independent input when required  Clear rationale for selection of invited bidders  Closed tender (3 major players) invited based on the rationale referred to above  A cross-functional Tender Sub-committee  Compliance with relevant regulatory notices

53

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SLIDE 54

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

1. Background about Bankmed 2. Insights on risk pooling successes resulting in better value 3. Investment by employer groups in health and wellness 4. Targeted focus on quality of healthcare 5. The challenge of behaviour change 6. An opportunity for collaboration and a phased response to necessary change 7. Bankmed’s recent change of administrator 8. Conclusion

Agenda

54

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SLIDE 55

The average Bankmed member is currently better off financially by an amount of

34% of contributions

versus if the member joined the average

  • pen medical scheme*

Conclusion

 Acknowledgement of an unsustainable system  Some issues not unique to South Africa  Acknowledgement of other socio-economic factors  Acknowledgement of positives  Medical schemes “price takers”  A call for stakeholders to rise above the inherent tension and work together  The tone about medical schemes must change  Solutions located in common interests and diverse insights  Interim dispensations should be part of the solution

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SLIDE 56

Thank You